The first results of the “bevolkingsonderzoek” in the Zaanstreek region in The Netherlands

This short communication describes the results with respect to stage of colorectal cancer in people detected via screening and patients with clinical complaints.     

Cervical mediastinoscopy in The Netherlands: past or present? A retrospective analysis of 218 procedures

BACKGROUND: Cervical mediastinoscopy (CM) has been considered the gold standard for the evaluation of mediastinal lymph nodes in the staging of non-small cell lung cancer (NSCLC) for many years. Recent publications on the value of PET scanning might reduce the use of CM in the near future. The aim of this study was to analyse the data of our CM procedures for their reliability and contribution in the assessment of mediastinal lymph nodes. METHODS: In the period 1995-1999, 219 patients underwent CM. Data were available on 218 procedures and were analysed retrospectively. CM was performed in 162 men and 56 women with a median age of 56 years [range 29 to 80 years]. RESULTS: Median hospitalisation time was three days. There was no mortality and morbidity was 6%. In 96% of procedures representative lymphoid tissue was obtained. In 24%, biopsies contained malignancy. CONCLUSIONS: CM is a relatively safe procedure with a high diagnostic yield. As long as PET scanning remains available at a limited level, CM remains the gold standard in The Netherlands for patients with apparently operable NSCLC.     

Do Dutch dermatologists care for venereology? An inquiry among all non-academic dermatologists in The Netherlands

The financing of STD outpatient clinics in The Netherlands is currently undergoing structural changes. Because these changes also have implications for the infrastructure of STD care as a whole, the STD committee of the Dutch Society for Dermatology and Venereology (STD committee NVDV) and the National Society of Municipal Health Services (GGD-Nederland) are currently exploring the possibilities and feasibility of intensified regional collaboration between Municipal Health Services (MHSs) and dermatologists. However, for fruitful collaboration it is essential that a substantial number of dermatologists has an interest in STD care. Therefore, the STD committee NVDV has conducted a structured survey in order to study the support of Dutch dermatologists for such a regional collaboration. In this paper, the results of the survey are presented. It appears that the majority of Dutch dermatologists is (still) interested in STD, and although a minority currently collaborates with local MHSs on a regular basis, a large group is willing to do so in the future. We conclude that the majority of dermatologists in the Netherlands (still) cares for venereology and that there is a sound basis for a fruitful cooperation with MHSs.     

Tuberculosis screening among immigrants in The Netherlands: what is its contribution to public health?

Understanding the epidemiology of tuberculosis in migrant communities and designing adequate and comprehensive control strategies is a major challenge facing public health authorities in many low-prevalence countries. In The Netherlands, screening immigrants from tuberculosis high prevalence countries has been conducted since 1966. In this paper, we review risk factors for tuberculosis in migrant populations, the public health importance of tuberculosis and the current screening policy in The Netherlands. TB treatment outcome in migrant populations and operational considerations that ought to be taken into account to optimize current screening practices are also reviewed. The article recommends the setting-up of an information system to evaluate the effectiveness of screening immigrants in The Netherlands, and adjustment of screening policies where needed.     

Are scratchcards addictive? The prevalence of pathological scratchcard gambling among adult scratchcard buyers in the Netherlands

Aims  To determine the prevalence of regular, potential problematic and pathological scratchcard gambling (PSG) 5 years after the introduction of scratchcards in the Netherlands.
Design and participants  A non-proportional stratified random sample of 12 222 scratchcard buyers was approached. Regular scratchcard buyers ( n  = 3342) were asked to fill out the South Oaks Gambling Screen (SOGS). Those with a SOGS score of 3 or more ( n  = 340) were interviewed with the gambling section of the DSM-IV Diagnostic Interview Schedule (DIS-T). Weighted data were used to obtain unbiased prevalence estimates.
Findings  The estimated prevalence of regular and potential problematic scratchcard gambling were 28.4% and 2.68%, respectively. Only 0.24% met DSM-IV criteria for PSG. Of those, only 0.09% were addicted uniquely to scratchcards. The remaining 0.15% were also addicted to other games of chance. Demographic and gambling characteristics of these 'combined' PSG (young men, mainly slot-machine players) resembled characteristics of pathological gamblers in general. In contrast to these 'combined' PSG, 'unique' PSG were mainly women between 25 and 34 years who spent relatively small amounts of money on scratchcards (equivalent to one scratchcard a day).
Conclusion  Scratchcards have a very low addiction potential among adults in the Netherlands. Given the specific characteristics of the unique PSG and the relatively small amount of money they spent, the appropriateness of DSM criteria for this particular form of gambling can be questioned.     

Ischaemic heart disease in Turkish migrants with type 2 diabetes mellitus in The Netherlands: wait for the next generation?

OBJECTIVE: To study the prevalence of ischaemic heart disease in Turkish and Surinam-Asian migrants with type 2 diabetes mellitus in the Netherlands as compared with Europeans. METHODS: In a consecutive case-control study, 59 Turkish and 62 Surinam-Asian patients were compared with 185 Europeans referred to a diabetes clinic for treatment of type 2 diabetes in the period 1992 to 1998. Main outcome measures were ischaemic heart disease and its associated risk factors. RESULTS: The prevalence of ischaemic heart disease was lower (9%) in the Turks (p < 0.02), but higher (29%) in the Surinam-Asians compared with the Europeans (23%). The Turks (52 +/- 10 years) and Surinam-Asians (46 +/- 12 years) were younger than the Europeans (64 +/- 11 years, p < 0.001). Body mass index was 32 +/- 5 (p < 0.001) in the Turks, 27 +/- 5 in the Surinam-Asians (p < 0.05) and 29 +/- 5 in the Europeans. Turkish patients smoked less (23%, p < 0.05) and used less alcohol (4%, p < 0.05) than the Europeans. Proteinuria was found in 24% of the Turks (p < 0.05), 37% of the Surinam-Asians (NS) and 46% of the Europeans. In univariate analysis ischaemic heart disease was related to Turkish origin, OR 0.34 (0.14-0.83) p < 0.02, to Surinam-Asian origin, OR 1.84 (1.00-3.38) p = 0.05, and smoking, OR 1.78 (1.18-2.68) p < 0.01. Other variables were not related to ischaemic heart disease. Multivariate analysis in a model with ethnicity and smoking showed significant relations between ischaemic heart disease and Turkish ethnicity, OR 0.19 (0.06-0.65) p = 0.007, Surinam-Asian origin, OR 2.77 (1.45-5.28) p = 0.002, and smoking, OR 1.79 (1.20-2.66) p = 0.004. CONCLUSION: Type 2 diabetes mellitus in different ethnic groups results in a significant difference in incidence of ischaemic heart disease. The most remarkable finding is a low incidence of ischaemic heart disease in the Turkish patients with type 2 diabetes, independent of smoking. The high prevalence of ischaemic heart disease in young migrant Asians with diabetes is confirmed.     

Pneumococcal vaccination for the elderly in The Netherlands? Assessment of the quality and content of available comparative studies

BACKGROUND: A question that is currently topical in the Netherlands is whether it makes sense to introduce on a national scale vaccination against pneumococcal infections for elderly people who are at present receiving the influenza vaccination. We recently studied the scientific literature on the subject in an attempt to answer this question. METHODS: We searched for systematic reviews (SRs), randomised clinical trials (RCTs) and cohort studies in MEDLINE, EMBASE, the Cochrane Library, Current Controlled Trials and via Google (period 1966 to June 2002). The SRs and RCTs were assessed with a methodological checklist. RESULTS: We identified four SRs, two trials (of which one was pseudo-random) and one retrospective cohort study. The methodological quality of the SRs was reasonable and in this respect differed little among themselves. The SRs differed strongly with regard to subgroups, outcome measures, valency of vaccines, duration of follow-up and combination with influenza vaccination. The SRs showed that vaccination has more effect in low-risk groups, does not appear to be effective in high-risk patients and the elderly and is more effective in nonindustrialised countries. The outcomes based on the various outcome measures showed major differences. The three studies into the effectiveness of the pneumococcal vaccination in the elderly all showed major methodological shortcomings. For the majority of outcome measures the outcomes were negative. CONCLUSION: There is insufficient convincing evidence in favour of the introduction of the pneumococcal vaccination as a supplement to influenza vaccination for the elderly. It seems as if (international) opinion had already been fully formed before published studies and systematic reviews become available in the last few years. It is perhaps worth considering setting up a prospective trial in the elderly Dutch population.     

Surveillance colonoscopy practice in Lynch syndrome in the Netherlands： A nationwide survey

Lynch syndrome, or hereditary nonpolyposis colorectal cancer (HNPCC), is the most common genetic disorder predisposing to colorectal cancer. As regular colonoscopic surveillance has been shown to reduce the incidence of colorectal cancer, this strategy is recommended worldwide. Recently, several advances in colonoscopic techniques have improved detection rates of neoplasia in Lynch syndrome. In this nationwide survey, we evaluated current surveillance colonoscopy practices for Lynch syndrome in the Netherlands and the extent to which advanced techniques have been adopted in routine clinical practice.     

What happens to patients starting dialysis in the Netherlands?

BACKGROUND: despite improvements in dialysis technology, publications around 1990 showed increasing mortality rates in dialysis patients. The Dialysis Group of the Netherlands initiated the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) to investigate the association of patient and therapy characteristics with outcome. METHODS: 250 patients were included in this prospective multicentre study 3 months after the start of dialysis. We used Cox regression to predict mortality and technique failure and repeated measures analysis of variance to study the time course of continuous parameters. RESULTS: there were considerable differences in patient populations among dialysis centres. Patient survival was 76% at 2 years. Technique survival was higher in haemodialysis. Hospitalisation decreased from 25 days between 3 and 12 months to 19 days per patient year in the third year. Residual renal function decreased at a similar rate in both modalities, but blood pressure tended to increase in females receiving peritoneal dialysis. Outcome was predominantly dependent on patient characteristics. CONCLUSIONS: In the light of the increasing age of patients starting dialysis, increasing mortality can be expected. Furthermore, if outcome is to play a role in the quality assessment of dialysis centres, it is essential to know the characteristics of their patient populations.     

A large increase of Salmonella infections in 2003 in The Netherlands: hot summer or side effect of the avian influenza outbreak?

In June 2003, the Dutch National Salmonella Centre reported a significant excess isolation rate of Salmonella Enteritidis when compared with earlier years in most regional public health laboratories. By the end of 2003, this amounted to an extra 540 laboratory confirmed cases for the whole of the Netherlands, which implies an estimated 7500 extra cases of gastroenteritis caused by S. Enteritidis in the general population, an increase of 50% on previous years. The hot summer could not explain the findings. Strong evidence has been found to suggest that the increase in importation of salmonella contaminated eggs, as a side effect of a concurrent avian influenza outbreak, was the most probable reason for this excess.     

The efficacy of combination antiretroviral therapy in HIV type 1-infected patients treated in Curaçao compared with Antillean, Surinam, and Dutch HIV type 1-infected patients treated in The Netherlands

We compared the efficacy of combination antiretroviral therapy (cART) of Antillean HIV-1-infected patients treated on the Caribbean island of Cura?ao (CUR-AN) with Antillean (NL-AN), Surinam (NL-SUR), and Dutch (NL-NL) patients treated in The Netherlands. In total 2118 therapy-naive patients who started cART between January 2005 and August 2008 were included in the comparison. The CUR-AN patients initiated cART at a median CD4 cell count of 141 cells/mm(3) and 63% had counts below 200 cells/mm(3). Within 12 months of the start of cART 76% of the CUR-AN patients achieved viral suppression, defined as HIV-1 RNA plasma levels below 80 copies/ml. The percentage achieving viral suppression was higher in patients treated in The Netherlands (NL-AN = 87%, NL-SUR = 93%, and NL-NL = 96%). Lost to follow-up after 30 months of cART was 10% among CUR-AN patients and was higher than observed among patients treated in The Netherlands (NL-AN = 8%, NL-SUR = 3%, and NL-NL = 2%). A similar pattern was found for progression to AIDS and death (10% of CUR-AN vs. 5%, 6%, and 7% of NL-AN, NL-SUR, and NL-NL patients, respectively). Late start of cART and limited viral suppression after the start of cART determine the higher rate of disease progression to AIDS and death among Antillean patients treated in Cura?ao. The high percentage of lost to follow-up may result in an underestimation of AIDS and AIDS-related death among HIV-1-infected Antilleans treated in Cura?ao.     

The hidden passenger of lucky bamboo: do imported Aedes albopictus mosquitoes cause dengue virus transmission in the Netherlands?

Since 2005, Aedes albopictus mosquitoes have been detected in companies in the Netherlands that import ornamental plants from China. To assess the risks of dengue transmission, a study was carried out in 48 persons who are professionally exposed to these mosquitoes. No evidence for non-travel-related flavivirus infections was found.     

MRSA in nursing homes in the Netherlands 1989 to 1998: a developing reservoir?

The prevalence of methicillin resistant Staphylococcus aureus (MRSA) in Dutch nursing homes in 1998 was higher than that found in 1989 to 1997. The increased prevalence of MRSA could lead to colonisation outside these nursing homes. A study of the prevale     

Trends in incidence,treatment and survival of aggressive B-cell lymphoma in the Netherlands 1989–2010

Only a small number of patients with aggressive B-cell lymphoma take part in clinical trials, and elderly patients in particular are under-represented. Therefore, we studied data of the population-based nationwide Netherlands Cancer Registry to determine trends in incidence, treatment and survival in an unselected patient population. We included all patients aged 15 years and older with newly diagnosed diffuse large B-cell lymphoma or Burkitt lymphoma in the period 1989–2010 and mantle cell lymphoma in the period 2001–2010, with follow up until February 2013. We examined incidence, first-line treatment and survival. We calculated annual percentage of change in incidence and carried out relative survival analyses. Incidence remained stable for diffuse large B-cell lymphoma (n=23,527), while for mantle cell lymphoma (n=1,634) and Burkitt lymphoma (n=724) incidence increased for men and remained stable for women. No increase in survival for patients with aggressive B-cell lymphoma was observed during the period 1989–1993 and the period 1994–1998 [5-year relative survival 42% (95%CI: 39%–45%) and 41% (38%–44%), respectively], but increased to 46% (43%–48%) in the period 1999–2004 and to 58% (56%–61%) in the period 2005–2010. The increase in survival was most prominent in patients under 65 years of age, while there was a smaller increase in patients over 75 years of age. However, when untreated patients were excluded, patients over 75 years of age had a similar increase in survival to younger patients. In the Netherlands, survival for patients with aggressive B-cell lymphoma increased over time, particularly in younger patients, but also in elderly patients when treatment had been initiated. The improvement in survival coincided with the introduction of rituximab therapy and stem cell transplantation into clinical practice.